新辅助化学疗法治疗食管癌后，残留疾病的患者长时间进行手术时间
Prolonged Time to Surgery in Patients with Residual Disease After Neoadjuvant Chemoradiotherapy for Esophageal Cancer
影响因子:6.40000
分区:医学1区 Top / 外科1区
发表日期:2024 Aug 13
作者:
Hidde C G Overtoom, Ben M Eyck, Berend J van der Wilk, Bo J Noordman, Pieter C van der Sluis, Bas P L Wijnhoven, J Jan B van Lanschot, Sjoerd M Lagarde,
摘要
为了调查长时间手术时间是否会对新辅助性食管癌的新辅助化学疗法治疗后，组织学证明的残留疾病的患者是否会对生存率产生负面影响，病理学结果或术后并发症。历史性地，手术的标准时间（TTS）已在NCRT完成后六到八周。长时间TT的影响正在引起人们的兴趣，这与生存和手术发病率的结果相矛盾。可以假设，在NCRT完成六周后，在残留疾病的患者中，长时间的TT可能与较差的生存率和更高的发病率有关。患有局部晚期食管癌的患者在NCRT和手术后六周进行了生物疾病的残留疾病，并根据手术进行了分类（tts> 12w vss> 12w vss）。这项研究的主要结果是总体生存。次要结局是无病生存，手术结果，病理结局和术后并发症。多变量COX回归用于比较其他结果的存活率和逻辑回归，并针对混杂因素，CT，CN，CHARLSON合并症指数，NCRT期间的体重减轻以及NCRT舒适患者完成后的性能得分。 TTS> 12W与更好的总生存期（调整危险比（AHR）0.46，95％CI 0.24-0.90）和无病生存期（AHR 0.48，95％CI 0.24-0.94）相关，但术后呼吸疾病还要多（AOR 3.666，95％CI 1.5959.59）。两组之间的其他结果是可比的。在组织学证明的残留疾病的患者NCRT完成后，食管癌癌症的长期疾病对整体和无疾病的生存没有负面影响，但术后呼吸道并发症的风险较高。
Abstract
To investigate whether prolonged time to surgery negatively affects survival, pathological outcome or postoperative complications in patients with histologically proven residual disease after neoadjuvant chemoradiotherapy for locally advanced esophageal cancer.Historically, the standard time to surgery (TTS) has been six to eight weeks after completion of nCRT. The effect of prolonged TTS is gaining interest, with contradicting results on survival and surgical morbidity. It can be hypothesized that, in patients with residual disease six weeks after completion of nCRT, prolonged TTS might be associated with worse survival and higher morbidity.Patients with locally advanced esophageal cancer who had biopsy-proven residual disease six weeks after nCRT and underwent surgery, were categorized according to interval to surgery (TTS>12w vs. TTS≤12w). Primary outcome of this study was overall survival. Secondary outcomes were disease-free survival, surgical outcomes, pathological outcomes, and postoperative complications. Multivariable Cox regression was used for comparing survival and logistic regression for other outcomes, adjusted for the confounders age, cT, cN, Charlson comorbidity index, weight loss during nCRT, and WHO performance score after completion of nCRT.Forty patients were included for TTS>12w and 127 for TTS≤12w. TTS>12w was associated with better overall survival (adjusted hazard ratio (aHR) 0.46, 95%CI 0.24-0.90), and disease-free survival (aHR 0.48, 95%CI 0.24-0.94), but also with more postoperative respiratory complications (aOR 3.66, 95%CI 1.52-9.59). Other outcomes were comparable between both groups.Prolonged TTS in patients with histologically proven residual disease after completion of nCRT for esophageal cancer did not have a negative effect on overall and disease-free survival, but patients did have a higher risk for postoperative respiratory complications.